Objective?To develop an augmented reality (AR) neuronavigation system with Web cameras and examine its clinical utility. Methods?The utility of the system was evaluated in three patients with brain tumors. One patient had a glioblastoma and two patients had convexity meningiomas. Our navigation system comprised the open-source software 3D Slicer (Brigham and Women's Hospital, Boston, Massachusetts, USA), the infrared optical tracking sensor Polaris (Northern Digital Inc., Waterloo, Canada), and Web cameras. We prepared two different types of Web cameras: a handheld type and a headband type. Optical markers were attached to each Web camera. We used this system for skin incision planning before the operation, during craniotomy, and after dural incision. Results?We were able to overlay these images in all cases. In Case 1, accuracy could not be evaluated because the tumor was not on the surface, though it was generally suitable for the outline of the external ear and the skin. In Cases 2 and 3, the augmented reality error was ?2 to 3 mm. Conclusion?AR technology was examined with Web cameras in neurosurgical operations. Our results suggest that this technology is clinically useful in neurosurgical procedures, particularly for brain tumors close to the brain surface.

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Continuous collection of imaging spectroscopic data is feasible and may provide reliable quantification of the hemodynamic responses in the brain. The HSC system may be useful for monitoring intraoperative changes in cortical surface hemodynamics during revascularization procedures in humans.

The proposed BB-STAMP is a promising method for replicating exactly what is performed during simulation without using a surgical navigation system.

Although many investigators have reported the hearing function in the immediate postoperative period in patients with vestibular schwannoma (VS), little is known about the long-term outcomes of the postoperative hearing. The aim of this study was to analyze the long-term hearing outcomes at a mean follow-up of 5 years in patients with unilateral VS treated via the retrosigmoid approach. Twenty-four patients with immediate postoperative serviceable hearing who underwent repeated audiogram or phone interview were included in this study. During the mean follow-up period (68.8 ± 30.2 months, range 14–123 months), serviceable hearing was preserved in 20 out of the 24 patients (83%). Pure tone average (PTA) was reevaluated within 6 months in seven patients. In the two patients whose PTA deteriorated ≥ 5 dB in 6 months after surgery, their PTA worsened ≥ 15 dB compared to the immediate postoperative PTA. In the remaining five patients whose PTA deteriorated < 5 dB in 6 months after surgery, PTA was maintained within a 15-dB deterioration at the final follow-up (p = 0.04, Fisher's exact test). According to Kaplan–Meier survival plots, the 5-year or 7-year preservation rate of serviceable hearing was 86.2% or 71.8%, respectively. Further study will be needed to clarify the mechanism underlying the long-term decline of serviceable hearing; however, the deterioration of PTA in the early postoperative period may help to predict the long-term outcomes of hearing.

Background/purpose We have invented multi-piercing surgery (MPS) which could potentially solve the triangular formation loss and device clashing which occur in singleport surgery (SPS), as well as restricted visual field, organ damage by needle-type instruments, and impaired removal of a resected organ from the body which occur in needlescopic surgery (NS). MPS is natural orifice translumenal endoscopic surgery (NOTES)-assisted NS. We used 3-mm diameter robots as needle-type instruments for MPS to examine the possibility of local immune cell therapy and regenerative therapy using stem cells for pancreatic cancer. Methods In MPS using two robots, the therapeutic cell suspension was injected into a target region of pancreas in two pigs. Both retention of a capsule of liquid cell suspension and invasive level were evaluated. Results Triangular formation could be ensured. The use of small-diameter robots allowed (1) the surgical separation of the pancreas and the retroperitoneum, and (2) the formation of the capsule containing the immune cell and stem cell suspension. The endoscope for NOTES provided a clear visual field and also assisted the removal of a resected organ from the body. The visual field of the endoscope could be oriented well by using an electromagnetic navigation system. Conclusions MPS using small-diameter robots could potentially solve the issues inherent in SPS and NS and could allow minimally invasive local immune cell and stem cell therapy.

Surgical microscope-integrated intraoperative angiography with intra-venous injection of indocyanine green (ICG) has been widely used during bypass or aneurysm surgery. Instead of intra-venous injection of ICG, we describe a case of intraoperative video angiography with intra-arterial injection of ICG in cerebral arteriovenous malformation (AVM) surgery. During the surgery, we injected ICG through a catheter placed in the internal carotid artery in each step. The technique was feasible and useful to distinguish feeders from normal arteries and to observe changes in flow dynamics. Intra-arterial injection of ICG had better phase contrast than intra-venous injection of ICG and better spatial resolution than digital subtraction angiography. Therefore, this technique can be helpful in cerebral AVM surgery.KeywoRds: Cerebral arteriovenous malformation, Indocyanine green video angiography, Intra-arterial injection ÖZİntravenöz indosyanin yeşil (ICG) enjeksiyonuyla cerrahi mikroskopla entegre intraoperatif anjiyografi, bypass veya anevrizma cerrahisi sırasında sıklıkla kullanılmaktadır. İntravenöz ICG enjeksiyonu yerine intraarteriyel ICG enjeksiyonuyla intraoperatif video anjiyografi gerçekleştirilen bir serebral anteriyovenöz malformasyon (AVM) cerrahisi bildiriyoruz. Cerrahi sırasında her adımda internal karotid artere yerleştirilmiş bir kateterden ICG enjeksiyonu yaptık. Tekniğin kullanımı besleyici damarların normal arterlerin ayırt edilmesi ve akış dinamiği değişikliklerinin gözlenmesi için uygun ve faydalıydı. ICG intraarteriyel enjeksiyonunun faz kontrastı intravenöz ICG enjeksiyonundan iyiydi ve uzaysal çözünürlüğü dijital subtraksiyon anjiyografisinden iyiydi. Bu nedenle bu teknik serebral AVM cerrahisinde faydalı olabilir.AnAhtAR sÖZCÜKleR: Serebral anteriyovenöz malformasyon, İndosiyanin yeşil video anjiyografi, İntraarteriyel enjeksiyon

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